Association between area-level walkability and glycated haemoglobin: a Portuguese population-based study.

Diabetes poses a substantial disease burden, prompting preventive interventions. Physical inactivity, a major risk factor for type 2 diabetes, can potentially be mitigated by enhancing area-level walkability. Despite this, limited population-based studies have investigated the link between walkability and objective diabetes measures. Our study aims to estimate the association between area-level walkability and individual glycated haemoglobin levels in the Portuguese adult population without the diagnosis of diabetes. Data from the 2011 census and an updated street map were obtained to construct a walkability index based on residential density, land-use mix, and street connectivity. Individual health data were sourced from The National Health Examination Survey (INSEF) 2015, a representative survey of the Portuguese adult population. Gamma regression was employed for estimation of the main associations, revealing that residing in moderately walkable areas significantly reduced average glycated haemoglobin levels (Exp(ß) = 0.906; 95% CI: 0.821, 0.999) compared to the least walkable areas. The association was less pronounced and not statistically significant for the third tertile of walkability (Exp(ß) = 0.919; 95% CI: 0.822, 1.028). Our findings highlight a nonlinear protective association between walkability and glycated haemoglobin, emphasizing the potential policy implications for urban planning, diabetes prevention, and health promotion.

Benchmarking Relevance for Hospital Design and Planning: An International Web-Based Survey.

OBJECTIVE: The study aims to investigate what design practitioners and healthcare facility managers deem as important benchmarking metrics worldwide, investigating country differences in benchmarking usage and which metrics are prioritized. BACKGROUND: Benchmarking is a regular practice in the healthcare sector, both for clinical and managerial aspects to compare, measure, and improve standardized processes. However, limited knowledge is available about benchmarking procedures in hospital planning, design, and construction. METHODS: A web-based survey was designed, revised, and pilot-tested in five countries; it was adjusted according to local experts' suggestions and submitted globally via SoSci multilingual platform to persons involved in hospital design, research, construction, and facility management. It was composed of closed questions on 5-point Likert-type scale ranking frequency or importance and open-ended questions divided into six sections. Two hundred and eighty full responses have been collected. Statistical analysis was performed via PowerBI and R-Studio, while qualitative analysis was performed via MAXQDA. RESULTS: The findings reported allow for both specific insights per each country or category as well as enabling general considerations of a practice that is becoming always more international with 30%-50% of respondents working in the international context. The evaluation of the survey highlights the most important benchmarks, among others. For example, for respondents from the top five countries (Sweden, Spain, Germany, Italy, and the United States), the most important metric for benchmark comparability is whether the project was new construction, new construction attached to an existing hospital, or interior renovation. Construction date, client type (public vs. private), and country of location were also generally rated as the most important metrics by respondents. Other metrics that were consistently rated as important globally included inpatient unit layout, walking distances, number of floors, and whether all patient rooms are private. Space-related metrics are considered very important elements in the design and planning of healthcare facilities worldwide. Regarding cost-related metrics, all countries consider the ratio construction cost per building gross area as the most important. CONCLUSIONS: Benchmarking emerges as a relevant tool for hospital design and planning as it can support efficiency, standardization, and confidence; currently, benchmarking is still underutilized due to the challenge of international comparison, access to data outside each specific company, and variation design metrics nationally. Benchmarking strategies should be further investigated to support knowledge exchange and to ensure reliable and comparable information globally.

Rethinking the Healthcare Facilities: The Role of the Buffer Space.

OBJECTIVES: A working group conducted a survey on the use of the principle of buffer space (BS), which in case of emergencies, could benefit healthcare settings. The aim of the preliminary investigation is to define new research lines in hospitals' functional design. BACKGROUND: The global experience of the COVID-19 pandemic highlighted challenges faced by hospitals when responding promptly to emergencies, including spatial reorganization and suspension of ordinary medical activities for ensuring adequate management of the emergency surge of patients. METHODS: The group designed questionnaires to be administered to healthcare staff and healthcare designers aimed at understanding varied conceptions and features of BSs. Content across the two surveys overlapped significantly, allowing for direct comparisons of responses, while also including tailored questions in relation to the respective experience and skills of the two groups of respondents. RESULTS: 102 healthcare professionals and 56 designers took part to the survey. Analysis of the responses permitted for initial recommendations regarding BS typology including (a) proximity to the emergency department (ED), intensive care units (ICUs), and inpatient wards (IWs); (b) location within hospitals but separate from other medical areas; (c) need for independent access; (d) organizational and spatial features similar to ED, ICUs, and IWs; (e) existing as a fully flexible operational space; and (f) BS bed capacity to be approximately 12% of ED beds. CONCLUSIONS: Although the analysis is related to the Italian context, the expansion of this preliminary research to alternate healthcare facilities and geographic areas is necessary for reaching a wide consensus by different professionals on this field. It serves as a starting point for future investigations regarding the implementation of BS in hospital settings.

New Requirements for post-COVID-19 Hospital Inpatient Wards: Evidence, Design Recommendations and Assessment Tools.

Background: The evolution of hospital infrastructures highlights the need of its physical space to respond to new technological, societal and epidemiological transformations such as those following the COVID-19 pandemic experience. Although the new emerged needs of user-centeredness, comfort and wellbeing within specific functional areas, there is still a lack of measurable indications for addressing these challenges in-patient wards. Study Design: The objective of this study is therefore to provide specific guidelines for the design of the in-patient ward, through measurable criteria and indicators based on evidence from the scientific literature, and to develop an assessment tool for its evaluation. Methods: A five-step process has been followed: (i) performing a literature review about hospital wards and wellbeing strategies, (ii) conducting a best practice analysis and comparison of a selection of international contemporary healthcare facilities, (iii) defining some dimensional requirements from the comparison, (iv) developing an assessment tool based on extracted criteria, (v) testing the tool on an existing project. Results: Amongst the criteria, several aspects have been highlighted ranging from qualitative indicators, as the clarity of wayfinding or the level of privacy, to quantitative values, as the percentage of single inpatient rooms or the distance between rooms and nursing stations. The assessment tool is composed by 20 indicators, associated to thematic areas and referred to three environmental units of the inpatient ward. Two types of scoring system are proposed. Conclusions: Starting from those considerations and tool wider applications, the future design of hospital wards could follow guidelines addressing user-centeredness, comfort and wellbeing.

Bridging therapeutic landscapes to architecture. International experience-based design strategies for healthcare infrastructures.

BACKGROUND AND AIM: in Italy, many cases studies of therapeutic green spaces are built into healthcare infrastructures, but only some of these follow the principles of healing gardens. Scientific literature and international case studies offer many contributions of evidence relating to how therapeutic green spaces can support traditional treatments. The paper analyze the relationship between indoor and outdoor spaces and healing gardens' features; the main research questions were: "Can we synthetize experience-based design strategies for therapeutic green spaces and healing gardens? How can we prioritize the most relevant ones for the healthcare infrastructures?" METHODS: Research Method is divided into three different steps: 1st case studies' selection; 2nd case studies' analysis, and 3rd quali-quantitative comparative matrix. RESULTS: ten case studies were identifiedfour of them have the therapeutic green space on the ground floor,despite of the other six having the healing garden on the rooftop.The best experience-based design strategies for the therapeutic green spaces or healing gardens development were identified from the previous comparison matrix, and divided into A.Safety, Security and Privacy; B.Accessibility; C.Physical and Emotional Comfort; D.Positive distraction; E.Engagement with Nature; F.Maintenance and Aesthetics; and G.Sustainability. CONCLUSIONS: The results obtained from the comparative matrix are qualitative and quantitative design elements in terms of type of element / space, percentage, perimeter, area, number, materiality, shape, color, among others. The quali-quantitative matrix is a useful and practical tool that allows the designer to have a base of design guidelines that can be later applied to the proposal of new therapeutic gardens.

Health and well-being key performance indicators in corporate sustainability disclosure. A review of sustainability reports from a sample of major European companies.

BACKGROUND AND AIM: Health and Well-Being (HWB) measurement represents a key issue for companies in all sectors and a core element of social sustainability, according to the Sustainable Development Goals (SDGs). Despite its importance for companies and in sustainability reporting, the topic has not been investigated yet from a cross-sectoral perspective. Therefore, this research aims to assess if health and well-being are disclosed in sustainability reports of the largest European companies. METHODS: The disclosure of Key Performance Indicators (KPIs) has been investigated and compared according to the main international frameworks of sustainability. The research focused on sustainability reporting from a sample of the 30 largest companies in three methodological steps. First, the inclusion of HWB issues has been analyzed, identifying references to the SDGs and ISO 45001 within the documents. A second level of analysis considered the adoption of the Global Reporting Initiatives (GRI) Standards, with particular attention to Health metrics (GRI:403). The third level of analysis aimed at researching health and well-being performances, linked to specific KPIs from two selected case studies. RESULTS: The review highlighted that all 30 companies generally refer to SDG 3 and SDG 8 in their sustainability reporting while 83%(n=25) of them also apply either Occupational Health and Safety ISO 45001 or Health metrics in GRI Standards; 22 (73%) companies adopted both GRI as the sustainability reporting standard and disclosed the adoption of ISO 45001 management system. Only in two cases, an additional structured framework for HWB is reported highlighting the need for more comprehensive KPIs, especially for employee's well-being. CONCLUSIONS: The study highlighted that health indicators disclosure is generally limited to GRI Standards disclosure. To achieve greater transparency in sustainability reporting, there is a need to further investigate the issue. (www.actabiomedica.it).

Structural accreditation of healthcare facilities: comparison of the requirements by Italian Presidential Decree 14/01/1997 and regional regulations. A proposal for updating the minimum environmental units at national level.

BACKGROUND AND AIM: The Decree of the President of the Italian Republic 14/01/1997 is the reference norm related to the accreditation of public and private healthcare structures. This guideline establishes the minimum structural, technological and organizational requirements that each structure operating in the Italian territory must comply with. METHODS: In occasion of the project work for the postgraduate training course in healthcare management by ALTEMS School, a team of researchers conducted a survey on the state of updating of the minimum structural requirements indicated in the norm-in particular those relating to hospital facilities- with those adopted by the individual regions through the analysis of the most up-to-date regional regulations. RESULTS: Precisely starting from the comparison of regional references and from the regulations on the subject of structural accreditation which suggest strategic environmental units and which address some key-aspects relating to the contemporary design of healing environments (i.e. semi-intensive care units, hybrid operating theatres, etc.), the outcome of the project work is to define a proposal to update the national reference document, also in the light of the currently changing needs in terms of hospital design. CONCLUSIONS: The research aims to become a starting milestone for future investigations. The team investigated - in this first phase - the functional areas listed in the norm, and the next step aims to extend the analysis also to the innovative functions (i.e. buffer spaces, hybrid operating theatres, sub-intensive care units, etc.) and/or introduced only the last years which have only been regulated in some regions.

Design for all A.U.D.I.T. (Assessment Universal Design & Inclusion Tool). A tool to evaluate physical, sensory-cognitive and social quality in healthcare facilities.

BACKGROUND AND AIM: Universal Design (UD) is the design of environments equally accessible and usable to the wider range of people regardless their abilities or disabilities. Various studies highlight the lack of evaluation tools to support decision makers to enhance inclusive environments, especially complex constructions with various users as healthcare facilities. The research proposes a tool to evaluate the quality of building according to UD through a new set of objective indicators with a performance-based approach. METHODS: the tool has been developed through three main phases: 1. Analysis of the state of the art through a systematic literature review and workshops with stakeholders and experts; 2. Elaboration of the evaluation framework following the Multicriteria analysis methodology; 3. Application, to test and validate the tool in hospitals. RESULTS: the tool, named Design for All A.U.D.I.T., evaluates the level of UD analyzing Physical, Sensory-cognitive, and Social quality through a set of criteria specified by indicators and measurable requirements. The tool assesses the different healthcare environments through criteria and indicators to verify the level of appropriateness in terms of UD. The tool provides report with quantitative, qualitative and graphical information in plan of the facility status and design strategies. CONCLUSIONS: The study proposes an innovative evaluation system to determine the inclusion of hospitals, both for projects and for existing buildings. The flexible structure allows the tool to beapplied in different building typologies, currently adopted to identify hospital's weaknesses and setting priorities of intervention on inclusion.

Covid-19 emergency management and preparedness in cross-border territories. Collection of experiences, needs and public health strategies in the framework of interreg GESTI.S.CO. project.

BACKGROUND AND AIM: The Covid-19 pandemic highlighted management difficulties in neighboring territories. The aim of the paper is to report the needs of different stakeholders during, before and after Covid-19 emergency with specific regard to challenges faced by public administrators in confined territories. METHODS: In the framework of Interreg GESTI.S.CO. project the study has been designed with two methodological steps: i) a co-design workshop and ii) a web-based survey. The workshop includes both an audience interaction session and focus groups. Then, starting from the focus group results, the survey has been designed with 30 questions and submitted to the 227 municipalities located between Italy and Switzerland to understand the implementation of Public Health strategies in local emergency planning. RESULTS: The interactive session highlighted that most of the critical issues are related to the lack of communication and planning in Public Health policies. The survey highlighted that the local emergency plans rarely integrate a section on health emergencies (30% Italy and 50% Switzerland). Only 20% of the respondents dedicated a section for Covid-19 emergency management. Most of them did not activate initiatives to support mental health. 90% of the municipalities did not cooperate with the neighboring country, but half of them think that it would have been much more useful. The 55% of the Italian respondents are currently updating their emergency plan and will implement it with some Public Health input. CONCLUSIONS: The study provides insights that can support policy makers in improving their strategy in responding to future pandemic. (www.actabiomedica.it).

Green space in hospital built environment. A literature review about therapeutic gardens in acute care healthcare settings before Covid-19.

Background and aim Hospital facilities are one of the most stressful environments and there is evidence that during Covid-19 having outdoor and green spaces helped medical staff and nurses to decrease the stress and anxiety level. Nevertheless, knowledge about the type of green space is limited. The aim of the study is to systematize the existing scientific literature on the topic in a specific time period.     Methods Scopus, Pubmed, and Cochrane library databases have been explored in a systematic way. Following the Prysma diagram 25 studies have been included. Descriptive statistics and content analysis have been performed to highlight green typologies, users and functional area involved, spatial focus, relationship between users and space and vegetation typology. The different topics have been clustered according to Kellert's biophilic framework.     Results Articles reviewed included studies from the 2000 to 2020. The selection led to the analysis of 25 documents; it was significant to understand the major areas of application (pediatrics, ma-ternity, oncology, hospitalization, etc) and forms of green (images, furniture, healing gardens, vegetable gardens, etc).   Conclusions The present review highlight the main characteristics of green space in hospital built environment with specific focus on pre-pandemic situation.

Built environment impact on people with dementia (PwD) health and well-being outcomes: a systematic review of the literature.

BACKGROUND AND AIM: The number of People with Dementia (PwD) is rising worldwide and represents a complex figure because of the changes in the cognitive sphere, altering perceptions of the Built Environment (BE). Even though the role of the built environment in the health and well-being of people it's nowadays well known, few studies analyze and evaluate the impact of specific Architectural Features. To this end, this contribution provides a systematic review that will underline the impacts of BE on the Health and Well-being of PwD and set a matrix of the relationship with measurable outcomes. METHODS: A literature review has been conducted on scientific databases. 40 studies that relate health outcomes and aspects of the built environment have been identified and organized on a comparison matrix that clearly shows the relationships between Architectural Features of BE and Health and Wellbeing Outcome. This matrix allows to identify which are the aspects that can impact on PwD as well as possible lacks. RESULTS: Many aspects appear to be widely explored, such as BPSD or wandering. In addition, significant gaps in the relationship between recognized aspects of the built environment recognized as relevant to the well-being of people with dementia and the real impacts on health outcomes such as the location and personalization of spaces. CONCLUSIONS: This study collected the most recent studies to underline the relationship between BE and dementia, providing a set of outcomes and architectural features that can be analyzed to assess the quality of BE for PwD.

Application of an evaluation tool for mega-hospital site sustainability. Assessment of public private partnership large sized healthcare infrastructures in European context.

BACKGROUND AND AIM: Healthcare facilities are large and complex infrastructures designed to respond to a growing need of sanitary services in specialized environments to serve an increasing population number while containing costs. New financial and design models emerged for large sized Hospital -Facilities (Mega-hospitals) but their site sustainability is questioned. METHODS: The paper focuses on a comparison -between European region case studies of Public Private Partnership (PPP) Mega-Hospitals. A total of 21 large sized hospitals in operation after 2010 have been compared with the application of the Assessment Tool for -Hospital Site Sustainability (ATHOSS). A specific focus on Turkish Hospitals has been also provided as the PPP model is widely adopted in this country. RESULTS: This analysis shows that Turkish cases gets general lower scores than European ones in terms of Construction Density and Community Connectivity (28%;50%), Alternative Transportation (18%; 50%), Site Development (26%; 38%). Connection to Natural World (30%; 52%) and Heat Island Effect (33%; 43%). Only in Development Density criteria (30%; 16%) the score was higher. It also emerged that gross floor area per bed ratio is much larger for Turkish cases (334m2/bed; 198 m2/bed) which can be interpreted as one of the weaknesses related to oversizing such infrastructures. CONCLUSIONS: The tool application highlighted some point of attention to be considered when designing and planning Mega-hospital facilities and improvement strategies for site sustainability are -suggested.

Evaluation of stakeholder opinion about Long Term Care Facilities for People with Dementia perceived quality: a web-based survey in the Italian context.

BACKGROUND AND AIM: Italy is a country where the percentage of elderly population is very high (23% over 65). The aim of the investigation is to bring out which aspects of the spaces intended to accommodate elderly People with Dementia pathologies should be most present and potentially interested in becoming cornerstones of a new model of Long-Term Care facilities (LTC). METHODS: This research uses a case studies analysis followed by a web based survey as methodological tools. The questions were identified following an analysis of recent European case studies. The survey has been submitted to a panel of stakeholders (users, pratictioner, designer and manager in the healthcare sector). It is articulated in eight items touching on functional, configurational, and perceptual aspects of the LTC. RESULTS: The 210 responses received provided a basis for comparison with the trend lines detected by the case study analysis, establishing continuity on some configurational aspects and providing divergent views for others. The research found a strong need to introduce new service activities and technologies aimed at the care and assistance of guests with dementia. These specific needs often involve the introduction of new spaces and environments or the redefinition of the same, where already present. CONCLUSIONS: The results highlights that a new model of residence must incorporate new technological applications, outdoor spaces, that are perceived significantly by both patients and practitioners, and improve well-being of all users.

The meta-projects of the new community health centers, community hospitals and local operative centers for the Italian country.

BACKGROUND AND AIM: COVID-19 highlighted significant criticalities of the Italian National Healthcare System (NHS) and recently the Italian Government approved the National Recovery and Resilience Plan (NRRP) to relaunch its economy and at the same time to promote health, sustainability and digital innovation. Specifically, M6C1 (Mission 6 Component 1) wants to introduce Community Health Centers (CHCs), Community Hospitals (CHs) and Local Operative Centers (LOCs) to strength territorial healthcare services. Starting from the Italian Ministerial Decree n. 77 (2022), AGENAS (National Agency for Regional Healthcare System) and POLIMI (Politecnico di Milano) working group developed the meta-design guidelines for CHCs, CHs and LOCs facilities with the aim of supporting decision-makers to define spatial features and building performances in order to be responsive to functional issues. METHODS: The spatial strategies of these facilities have been elicited through three different steps: a) a survey about the current national and international scenario regarding the territorial healthcare; b) a review of all national and regional regulations; c) the development of the meta-design guidelines have been elaborated from the analysis of the a) and b) steps. RESULTS: The regulatory instructions and scientific indications collected through the literature have been translated into spatial and functional layouts. The services have been organized by homogeneous macro-areas and defined in a synoptic framework which shows the performance approach and their features. Each macro-area, sorted by type of functions, has been subdivided into a list of all its specific spatial units. CONCLUSIONS: The study conducted aims at supporting the planning of these facilities in relation to the catchment area and their sizing. It will be necessary to define the location by evaluating the possibility of setting them up within existing hospitals, as well as to guarantee a sustainable approach in the realization of these infrastructures.

Lessons from the first wave of COVID-19 in Italy: A collection of design strategies to face pandemic situations in healthcare facilities.

OBJECTIVES: This study aims to provide metadesign indications for the improvement of healthcare facilities, emphasizing the role of spatial design in the management of epidemic health emergencies. STUDY DESIGN: A parallel mixed-method study including literature reviews, survey creation, and survey distribution was performed. METHODS: Data were collected between August and October 2020 capturing information related to the first wave of the COVID-19 pandemic, utilizing a review of existing literature, a comparison of existing hospital planning guidelines and assessment tools, and distribution of a survey to analyze design changes within selected Italian hospitals. RESULTS: Among the changes identified, the most frequently identified included the conversion of space into intensive care units, space expansion, and the usage of wayfinding strategies for the reduction of cross-contamination risks. There was limited attention given to solutions with a human-centered approach, and those that addressed physical and psychological well-being of all users, including healthcare staff. The solutions were collected and systematized into a list of metadesign guidelines. CONCLUSIONS: The resulting indications represent a starting point for developing design solutions to aid healthcare facilities in facing future epidemics.

Can Homes Affect Well-Being? A Scoping Review among Housing Conditions, Indoor Environmental Quality, and Mental Health Outcomes.

The purpose of the scoping review is to explore the relationship between housing conditions, indoor environmental quality (IEQ), and mental health implications on human well-being. In fact, time spent at home increased due to the recent COVID-19 lockdown period, and social-sanitary emergencies are expected to grow due to the urbanization phenomenon. Thus, the role of the physical environment in which we live, study, and work, has become of crucial importance, as the literature has recently highlighted. This scoping review, conducted on the electronic database Scopus, led to the identification of 366 articles. This, after the screening processes based on the inclusion criteria, led to the final inclusion of 31 papers related specifically to the OECD area. The review allowed the identification of five housing conditions [house type, age, and floor level; housing qualities; household composition; neighborhood; green spaces] that, by influencing the IEQ parameters, had impacts on the mental health outcomes addressed. By synthesizing the contributions of the review, a list of design recommendations has been provided. These will serve as a basis for future researchers, from which to develop measures to reduce inequalities in housing by making them healthier, more resilient, and salutogenic.

Communities, Sport, Inclusion. Strategies for Parish Complexes Social Reactivation Through Sport Practice Promotion.

The following contribution presents some findings deriving from the research project "Sport is Society" by Politecnico di Milano. The research reflects on the built heritage and its ability to be accessible and usable for different users with different needs in its structures and offer of services, focusing on sports activities and spaces. The study refers to collective ecclesiastical structures in the contemporary city. The research in this area demonstrates the possible degrees of innovation regarding the increase in the inclusiveness of private facilities with a public vocation, where sport represents a driver of social inclusion for the community. The research proposes advice to guarantee inclusive sports facilities for the community, highlighting the strict relationship between the inclusive city and the ecclesiastical heritage, as an emerging issue to be investigated and solved. Starting from its relevance and the potential of the structures to become a truly "accessible patrimony", the tool suggests strategies for policymakers and ecclesiastical administrations to make them become "open services" - usable and accessible by all - for and inside the urban community.

Healthcare Facilities and Dementia Development of a Framework to Assess Design Quality.

In recent years, thanks to advances in medicine and the role of prevention, life expectancy has experienced rapid growth (from 77.6 to 81.3 years), resulting in an increase in Non-Communicable Diseases (NCDs) and years lived with disability. One of these is dementia, with about 7 million people currently affected in Europe while the number is set to double by 2050. These patients are complex due to the serious changes in their cognitive sphere, altering perceptions of their physical space. Because of age and multimorbidity, they are the most frequent users of healthcare facilities, but these structures often are not suitable to them. For example, during the COVID-19 pandemic, healthcare facilities demonstrated criticalities in structural and social issues. To this end, a rethinking of these spaces is urgent, and the use of Evidence-Based Design (EBD, the design based on findings from scientific research) can be a method to create safe and suitable environments. This study aims to develop an evaluation framework to assess the design quality of healthcare facilities for people with dementia. A systematic literature review was conducted to define a set of requirements that the space must have to be prosthetic for the patient. The framework consists of three macro areas (i.e., physical, social, and cognitive aspects), seven criteria, and 24 sub criteria. The proposed framework is a starting point for the development of inclusive projects for people with dementia and cognitive disabilities. Architecture has recently begun to approach the topic of dementia, especially in Italy. Therefore, it is urgent to investigate which are the main aspects to be considered in the design and renovations of facilities to make them as therapeutic and prosthetic as possible, creating places where the wellbeing of patients is the priority, both physical and psychological. To this end, EBD needs to become a habit for designers to create facilities suitable for people with both cognitive impairments and for every user, in line with the principles of Universal Design.

Designing Hospitals Through the Lens of Universal Design. An Evaluation Tool to Enhance Inclusive Healthcare Facilities.

Various studies highlight a gap on reliable methods to measure the quality of projects and environments in terms of Universal Design (UD) and Design for All (DfA). In particular, healthcare facilities need decision support systems to improve the well-being of as many users as possible through a systematic approach. The present research proposes an evaluation tool to support designers and decision makers in the adoption of UD to develop healthcare facilities suitable for a wide range of users. Several methodologies have been adopted: an in-depth literature review on the current state of knowledge on UD evaluation, workshops and focus groups with both users and experts, and the analysis of four hospital case studies. The result was an evaluation framework built by using a Multi-criteria Analysis (MCA) methodology. The first version of the tool was applied to an American hospital and validated d in an Italian pilot case study. The research outlines a tool called Design for All A.U.D.I.T., able to evaluate Physical, Sensory-cognitive, and Social qualities based on a hierarchical framework with criteria and indicators based on UD and DfA. The framework evaluates the different areas of the hospital from outdoor to indoor spaces, allowing hospital administrators to act to improve the well-being of users according to the critical aspects of UD identified by the tool. The analysis provides a report of the facility status and design strategies to support designers for new projects or buildings renovations. The application shows that DfA A.U.D.I.T. can assess hospitals by examining both spatial qualities and DfA criteria. The tool could represent a decision support system in the national and international context, where many hospitals are not newly built. Further research will include application in different facilities and building typologies, aided by the flexible structure of the tool, which allows measurement of the environment's quality in terms of DfA and UD.

Effect of Housing Quality on the Mental Health of University Students during the COVID-19 Lockdown.

COVID-19 outbreak imposed rapid and severe public policies that consistently impacted the lifestyle habits and mental health of the general population. Despite vaccination, lockdown restrictions are still considered as potential measures to contrast COVID-19 variants spread in several countries. Recent studies have highlighted the impacts of lockdowns on the population's mental health; however, the role of the indoor housing environment where people spent most of their time has rarely been considered. Data from 8177 undergraduate and graduate students were collected in a large, cross-sectional, web-based survey, submitted to a university in Northern Italy during the first lockdown period from 1 April to 1 May 2020. Logistic regression analysis showed significant associations between moderate and severe depression symptomatology (PHQ-9 scores ≥ 15), and houses with both poor indoor quality and small dimensions (OR = 4.132), either medium dimensions (OR = 3.249) or big dimensions (OR = 3.522). It was also found that, regardless of housing size, poor indoor quality is significantly associated with moderate-severe depressive symptomatology. Further studies are encouraged to explore the long-term impact of built environment parameter modifications on mental health, and therefore support housing and public health policies.